Recommended Laboratory Packages for Common Diseases
The recommended laboratory testing for common diseases should include disease-specific panels that focus on diagnosis, monitoring disease progression, and assessing complications. These laboratory packages are essential for effective disease management as 60-70% of critical decisions in diagnosis and treatment involve quantifiable laboratory data 1.
Diabetes Mellitus
Initial Diagnosis
- Fasting plasma glucose ≥126 mg/dL (7.0 mmol/L) after at least 8 hours of fasting 2
- 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during oral glucose tolerance test using 75g of anhydrous glucose 2
- Random plasma glucose ≥200 mg/dL (11.1 mmol/L) with classic symptoms of hyperglycemia 2
- HbA1c ≥6.5% (48 mmol/mol) using a method certified by the National Glycohemoglobin Standardization Program 2
- For type 1 diabetes: pancreatic autoantibodies (GAD65, IAA, IA-2, ZnT8, ICA) and C-peptide levels 2
Monitoring Package
- HbA1c every 3-6 months (up to 4 times per year if not achieving target or change in therapy) 3
- Fasting blood glucose and/or self-monitoring of blood glucose 3
- Annual comprehensive metabolic panel including electrolytes, renal function, and liver function 3
- Annual lipid profile (total cholesterol, LDL, HDL, triglycerides) 3
- Annual urinary albumin-to-creatinine ratio to detect early kidney damage 3
- Annual serum creatinine with eGFR 3
Special Considerations
- For patients with chronic kidney disease (CKD): consider using albumin or fructosamine instead of HbA1c for glycemic control evaluation 3
- For patients on dialysis: HbA1c is not reliable; consider continuous glucose monitoring 3
Hypertension
Initial Evaluation
- Complete blood count 3, 4
- Fasting blood glucose 3, 4
- Lipid profile 3, 4
- Serum creatinine with eGFR 3, 4
- Serum electrolytes (sodium, potassium) 3, 4
- Thyroid-stimulating hormone 3, 4
- Urinalysis 3, 4
- 12-lead electrocardiogram 3, 4
- Urinary albumin-to-creatinine ratio 3, 4
- Serum uric acid 3, 4
Monitoring Package
- Regular blood pressure measurements (office and home monitoring) 3, 4
- Annual metabolic panel (electrolytes, renal function) 3
- Annual urinary albumin-to-creatinine ratio 3, 4
- Periodic electrocardiogram to assess for left ventricular hypertrophy 3
Additional Testing Based on Clinical Presentation
- Echocardiography for patients with uncontrolled hypertension or abnormal ECG findings 3, 4
- Renal ultrasound for patients younger than 30 years, with poor response to treatment, or suspected secondary hypertension 3, 4
Chronic Kidney Disease
Initial Evaluation
- Serum creatinine with eGFR 3
- Urinary albumin-to-creatinine ratio 3
- Complete blood count 3
- Serum electrolytes (sodium, potassium, bicarbonate) 3
- Blood urea nitrogen 3
- Serum calcium, phosphorus 3
- Parathyroid hormone (if eGFR <60 ml/min/1.73m²) 3
- Renal ultrasound 3
Monitoring Package
- Regular monitoring of serum creatinine and eGFR 3
- Regular monitoring of urinary albumin-to-creatinine ratio 3
- Serum electrolytes, particularly potassium and bicarbonate 3
- Hemoglobin monitoring for anemia 3
- Calcium, phosphorus, and parathyroid hormone levels (frequency based on CKD stage) 3
Special Considerations
- For diabetic patients with CKD: more frequent monitoring of glycemic control and adjustment of antidiabetic medications 3, 5
- For hypertensive patients with CKD: more aggressive blood pressure targets (<130/80 mmHg if albuminuria >30 mg/24h) 3
Liver Disease
Initial Evaluation
- Standard liver panel: bilirubin, albumin, ALT, ALP, and GGT 3
- Complete blood count with platelets 3
- Prothrombin time/INR 3
- Viral hepatitis screening: Hepatitis B surface antigen and Hepatitis C antibody 3
- Iron studies: ferritin and transferrin saturation 3
- Autoimmune markers: anti-mitochondrial antibody, anti-smooth muscle antibody, antinuclear antibody, serum immunoglobulins 3
- Metabolic disease markers: alpha-1-antitrypsin level, ceruloplasmin (age 3-40 years) 3
Monitoring Package for Nonalcoholic Fatty Liver Disease (NAFLD)
- Liver panel (AST, ALT, bilirubin, alkaline phosphatase) 3
- Complete blood count 3
- Fasting lipid profile 3
- Fasting glucose and/or HbA1c 3
- International normalized ratio (INR) 3
- Serum creatinine 3
Additional Testing for Cirrhosis
- Regular alpha-fetoprotein and liver ultrasound for hepatocellular carcinoma screening 3
- Endoscopy for esophageal varices screening 3
Infectious Diseases
General Screening
- Complete blood count with differential 6
- C-reactive protein and/or erythrocyte sedimentation rate 6
- Blood cultures (for suspected bacteremia) 6
- Urinalysis and urine culture (for suspected urinary tract infections) 6
- Specific serological tests based on suspected pathogens 6
Viral Hepatitis
- Hepatitis B panel: HBsAg, anti-HBs, anti-HBc 3
- Hepatitis C antibody with follow-on PCR if positive 3
- Quantification of hepatitis delta in high-prevalence areas 3
- Liver function tests 3
- Complete blood count 3
HIV Infection
- HIV antibody/antigen testing 6
- CD4+ T-cell count 6
- HIV viral load 6
- Complete blood count 6
- Comprehensive metabolic panel 6
- Screening for co-infections (hepatitis B, hepatitis C, tuberculosis, syphilis) 6
Important Considerations
- Laboratory testing should be tailored based on disease severity, comorbidities, and medication regimens 1
- Regular monitoring intervals should be adjusted based on disease control and stability 3
- For patients with multiple conditions (e.g., diabetes and CKD), testing should be coordinated to avoid duplication while ensuring comprehensive evaluation 3, 5
- Interpretation of results should consider potential interferences (e.g., HbA1c may be unreliable in conditions affecting red blood cell turnover) 3, 2
- Cost-effectiveness should be considered when ordering laboratory tests, focusing on those that will impact clinical decision-making 1, 6